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REVIEW ARTICLE
Year : 2016  |  Volume : 16  |  Issue : 3  |  Page : 174-178

Effect of resistance exercise training on blood pressure in Indians: Systematic review


1 Department of Physiotherapy, GJUS and T, Hisar, Haryana, India
2 Human resource Devlopment Centre, GJUS and T, Hisar, Haryana, India

Date of Web Publication28-Sep-2016

Correspondence Address:
Sonu Punia
Department of Physiotherapy, GJUS and T, Hisar, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-6308.191332

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  Abstract 

Backround: Hypertension (HTN) is an emerging "silent killer" causing 6% deaths worldwide. HTN is defined as systolic blood pressure (BP) ≥140 mmHg, a diastolic BP (DBP) ≥90 mmHg. Methodology: A database of randomized controlled trials on the effect of exercise training on BP is searched. A systematic search was conducted of resistance training for the period November 1, 2015, until February 28, 2016. The search strategy included key words RE, training, BP, and India, and these were combined with a sensitive search strategy to identify randomized controlled trials. About 1220 articles published since 2012 were identified for review. Of these 1220 publications, 93 trials were included in the review. Some of these trials involved several groups of individuals or applied different training regimens so that a total of six studies were used for review. Collectively, exercise intervention length minimum from 4 weeks. For those studies that reported data, the between study frequency ranged from 1 to 7 times per week, and intensity ranged from 30% to 100% of 1 repetition maximum (RM) for dynamic resistance training. Resuts: The results suggest that there was a mean reduction of 4.84 mmHg in SBP and 3.11 mmHg in DBP in resistance training group. Conclusion: The present review concludes that RE training reduces the BP in Indians.

  Abstract in Arabic 

تأثير تمارين المقاومة على ضغط الدم في الهنود: مراجعة منهجية
خلفية البحث: ارتفاع ضغط الدم (HTN) هو "القاتل الصامت" الناشئة الذى نسبب فايات تصل الى 6٪ في جميع أنحاء العالم. ويعرف HTN بضغط الدم الانقباضي(SBP) (140≤) او الانبساطي (DBP) (90≤) . منهجية البحث: أجري هذا البحث المنهجي على قاعدة بيانات من تجارب عشوائية محكمة عن تأثير تمارين المقاومة (RE) على ضغط الدم فى الفترة من 1 نوفمبر 2015 حتى 28 فبراير 2016 .وتضمنت استراتيجية البحث الكلمات الرئيسية (RE)، والتدريب و (BP)، والهند، وهذه كانت مجتمعة مع استراتيجية البحث.النتائج: تم التعرف على هوية 1220 من المقالات المنشورة منذ عام 2012 تم إدراج 93 من الدراسات التجريبيةفي هذا الاستعراض. بعض هذه التجارب شارك فيها عدة مجموعات من الأفراد أو طبقت فيها نظم تدريب مختلفة بحيث تم استخدام مجموعه ست دراسات للمراجعة. تلك الدراسات التي جمعت فيها بيانات، تراوح بين الدراسة تكرار التجربة من 1الى 7 مرات في الأسبوع، وتراوحت شدة التمارين من 30٪ إلى 100٪. وتشير النتائج إلى أن كان هناك انخفاضا فى ضغط الدم الانقباضي (SBP) 4.84 مم زئبق وفى 3.11 مم زئبق في ضغط الدم الانبساطي (DBP) في مجموعة التدريب المقاومة. الخلاصة: يختتم هذا الاستعراض أن ممارسة تمارين المقاومة تقلل من BPضغط الدم في الهنود.

Keywords: Blood pressure, postexercise hypotension, resistance, training


How to cite this article:
Punia S, Kulandaivelan S, Punia V. Effect of resistance exercise training on blood pressure in Indians: Systematic review. Saudi J Sports Med 2016;16:174-8

How to cite this URL:
Punia S, Kulandaivelan S, Punia V. Effect of resistance exercise training on blood pressure in Indians: Systematic review. Saudi J Sports Med [serial online] 2016 [cited 2022 Aug 13];16:174-8. Available from: https://www.sjosm.org/text.asp?2016/16/3/174/191332


  Introduction Top


Hypertension (HTN) is an emerging "silent killer" causing 6% deaths worldwide. HTN is defined as systolic blood pressure (BP) ≥140 mmHg, a diastolic BP (DBP) ≥90 mmHg. Global statistics reveal an incidence that ranges between 3-18% and 26%. Epidemiology data from individual countries reveal the prevalence of 28.6% in the United States (Ihab Hajjar 2007), 20.3% in India (Anchla et al. 2013), 37.5% in rural China (Sun 2007), 43% in South Africa (Thorogood 2007), and 44% in European countries. [1]

A study was undertaken to assess the prevalence of HTN, and knowledge, treatment practice, and risk behaviors of tribal men and women ≥ 20 years in nine major states in India during 2008-2009 by National Nutrition Monitoring Bureau. Overall age-standardized prevalence of HTN was 26.3% (self-reported: 5.5%; newly detected: 20.8%). Urban residents of Tamil Nadu, Jharkhand, Chandigarh, and Maharashtra (31.5, 28.9, 30.7, and 28.1%, respectively) had significantly higher prevalence of HTN compared with rural residents (26.2, 21.7, 19.8, and 24.0%, respectively). [2]

An alarming rise in HTN projected by Global Burden of HTN 2005 study, the Global Burden of Disease 2010 study and WHO 2011 noncommunicable disease, India, specific data portray a grim picture for the 17.8% of the world's population who reside in India. Previously, a systematic review on the prevalence of HTN in India, for studies published between 1969 and July 2011, reported a range between 13.9-46.3% and 4.5-58.8% in urban and rural areas of India, respectively. The regional variations (between urban and rural) reported in the prevalence of HTN are also seen in cardiovascular diseases. [3]

A recent Meta-analysis from India (1950-30 April 2013) was searched for "prevalence, burden, awareness, and control of BP or HTN (≥140 systolic BP [SBP] and or ≥ 90 DBP) among Indian adults" (≥18 years). Of the total 3047 articles, 142 were included. Overall prevalence for HTN in India was 29.8% (95% confidence interval: 26.7-33.0). Significant differences in HTN prevalence were noted between rural and urban parts (27.6% {23.2-32.0} and 33.8% [P ≤ 0.05]). [4]

HTN is a multifactorial and multicausal syndrome usually associated with metabolic, hormonal, and structural disorders, and representing a primary risk for coronary disease.

HTN management comprises drug and/or nondrug therapeutic approaches. Although there is clear evidence that antihypertensive medications are useful in controlling HTN and reducing the incidence of stroke and infarction, long-term drug treatment can be expensive and side-effects can threaten patients' adherence to drug prescriptions. The identification of nonpharmacological methods to prevent or significantly delay the onset of HTN would represent an important advance in the prevention of cardiovascular disease. [2],[3] Among nondrug approaches, lifestyle changes recommended include weight reduction, a diet rich in fruits, vegetables, and low-fat dairy products with a reduced content of saturated and total fat, dietary sodium reduction, engagement in the regular aerobic physical activity, and limited alcohol consumption. Higher levels of physical activity and cardiorespiratory fitness have been shown to reduce the risk of HPT in healthy normotensive persons. Acute and chronic exercise can also reduce resting BP in hypertensive adults. Moreover, exercise training has been shown to improve several factors involved in the pathophysiology of HPT including sympathetic activity, endothelial function, 16 pulse wave velocity, and insulin sensitivity. Moderate-intensity continuous exercise training has been traditionally recommended for healthy and hypertensive subjects. [5],[6],[7]

In foreign, few studies have investigated postresistance exercise (RE) hypotension, with some studies showing maintenance or even increase in BP after resistance training program. [8] In India, some studies showing a reduction in BP after resistance training session. [9],[10],[11],[12]


  methodology Top


Search strategy

A database of randomized controlled trials on the effect of exercise training on BP is searched. A systematic search was conducted of resistance training for the period November 1, 2015, until February 28, 2016. The search strategy included key words RE, training, BP, and India, and these were combined with a sensitive search strategy to identify randomized controlled trials.

The inclusion criteria for this meta-analysis were as follows: (1) Experimental study of exercise training for a minimum of 3-4 weeks; (2) participants were adults (age 20-60 years); (3) the study reported before and after mean and standard deviation (SD) (or standard error) of resting BP in exercise and control groups or mean change and SD (or standard error) in exercise and control groups; and (4) the study was published in a journal up to February 2016. Any studies not meeting these criteria were excluded.

Statistical analysis

The primary outcome measures were changes in resting SBP and DBP. Descriptive data of treatment groups and participants are reported as the mean SD or median and range. Effect sizes for each study group were calculated by subtracting the pre-exercise value from the postexercise value (post-pre).

Literature search

About 1220 articles published since 2012 were identified for review. Of these 1220 publications, 93 trials were included in the review. Some of these trials involved several groups of individuals or applied different training regimens so that a total of six studies were used for review.

Collectively, exercise intervention length minimum from 4 weeks. For those studies that reported data, the between study frequency ranged from 1 to 7 times per week, and intensity ranged from 30% to 100% of 1-repetition maximum (RM) for dynamic resistance training.


  Results Top


Resistance training is activity in which each effort is performed against a specific opposing force generated by resistance and is designed specifically to increase muscular strength, power, and/or endurance. According to the type of muscle contraction, resistance training can be divided into two major subgroups: "Dynamic" versus "static or isometric" resistance training. Dynamic resistance training involves concentric and/or eccentric contractions of muscles, whereas both the length and the tension of the muscles change. [3] The entire four articles are from North India and are a recent one.

Shenoy et al. [13] 2009 studied the effects of 16 weeks RE on BP of Type 2 diabetics. They recruited 10 Type 2 diabetics' patients (40-70 years) to RE. The training protocol consists of warmup (static cycling), resistance training phase, and a cool-down phase (static cycling). The resistance training phase included three sets of the following seven exercises: Biceps curls, triceps curls, front lateral pull down, back lateral pull down, knee extension exercises on quadriceps table, hamstring curls using quadriceps table, and abdominal curls. At 0 week, 1 RM was calculated for each exercise. Training started with 60% of 1 RM and was progressed to 100% of 1 RM during the first 8 weeks of the training period. After 8 weeks, 1 RM was assessed again, and the intensity of exercises was again progressed from 60% of new 1 RM to 100% for the next 8 weeks. Subjects performed 10 repetitions per set for all exercises. Pre- and postoutcome measures BP was noted. SBP and DBP showed a reduction by 7.1% and 9.7%, for SBP and DBP, respectively, in RE group (SBP reduced from 126 ± 6.8 to 117 ± 4.6 mmHg and DBP from 82 ± 3.6 to 83 ± 3.7 mmHg).

Arora et al. [14] 2009 studied the effects of 8 weeks RE on BP of Type 2 diabetics (40-70 years). Ten subjects were randomly assigned to RE. Subjects exercised two times per week. Each session started with a 5 min warmup (static cycling) followed by seven exercises for major muscle groups. Subjects performed 3 sets of 10 repetitions of each exercise per session for two times a week. This was followed by 5 min cool-down (static cycling). The PRT protocol was designed to provide a progressive increase in intensity. At 0 week, 1 RM was calculated for each exercise using Brzycki's equation. Training started with 60% of 1 RM and was progressed to 100% of 1 RM during the 8 weeks training period. Pre- and post-outcome measures BP was noted. SBP was significantly in RE groups by 6.5%, respectively, as compared with control subjects (P < 0.05). There was a significant change in DBP. SBP reduced from 126 ± 6.8 to 118 ± 5.1 and DBP reduced from 82 ± 3.6 to 77 ± 4.1 mmHg.

Chaudhary et al., [9] 2010, investigated the effect of resistance training on cardiovascular fitness in 10 obese sedentary females (35-45 years) for 6 weeks. Training protocol consisting with intensity of four sets of 10 repetitions and frequency was three times/week. Training started with 10 lifts with 50% of 10 RM, then 75% of 10 RM, and progressed to 100% of 10 RM. Regular aerobic training reduced SBP from 128.10 ± 4.954 mmHg to 124.20 ± 2.820 mmHg and DBP from 85.00 ± 3.265 mmHg to 81.80 ± 3.119 mmHg. There was a significant reduction in resting BP (mean SBP − 3.9 ± 2.134 mmHg and DBP − 3.2 ± 0.146 mmHg).

Changela, [10] 2013, done an experimental study to study the effect of resistance training on cardiovascular fitness in 10 young obese sedentary females (19-25 years). Resistance training started with 10 lifts with 50% of 10 RM, then 75% of 10 RM, and progressed to 100% of 10 RM. Results showed SBP reduced from 131.70 ± 4.667 to 127.20 ± 3.190 mmHg and DBP reduced from 83.00 ± 2.160 to 82.60 ± 1.349 mmHg and significant mean difference in SBP (−3.73 ± 0.15 mmHg) and DBP (−1.73 ± 0.49 mmHg).

Patel et al., [11] 2014, investigated the effect of aerobic training on 30 hypertensive patients (30-55 years). Training given for 30 min duration included warmup and cool-down time for 6 weeks. Results showed mean difference was − 1.60 ± 0.503 SBP and − 1.80 ± 0.410 mmHg for DBP after 6 weeks.

Jaiswal et al., [12] 2015, evaluated the effect of circuit training on BP, heart rate, and rate of perceived exertion in individuals with 15 prehypertensive subjects (20-40 years). RE was given 30 min with intensity of 60% to 80% of 1 RM for 5 days in a week for 6 weeks. Regular resistance training reduced SBP from 128.26 ± 2.91 to 124.53 ± 3.06 mmHg and DBP reduced from 81.73 ± 2.12 to 80.00 ± 2.61 mmHg. Author showed mean difference of SBP (−3.73 ± 0.15) and DBP (−1.73 ± 0.49) [Table 1].
Table 1: Effect of resistance exercise in Indians

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  Discussion Top


The results suggest that there was a mean reduction of 4.84 mmHg in SBP and 3.11 mmHg in DBP in resistance training group. The findings of this study about the response of SBP to RE corroborate the results in the scientific literature of India about the acute and chronic benefits of this type of exercise. [1]

Mota et al., 2013, showed a decrease in the postexercise hypotension (PEH) of approximately 13.0 mmHg in month 2 and about 5.6 mmHg in month 3 for SBP in the experimental group and PEH magnitude of approximately 7.9 mmHg in month 2 and about 2.7 mmHg in month 4 for the subjects, who trained The average reduction in SBP at the end of the training period was 14.3 mmHg, a relevant result with regard to nonpharmacological approaches for prevention, treatment, and control of HTN in elderly women. [15]

It is clear from the literature of Western countries that PEH is an acute benefit from physical exercise. Its mechanisms are not clear, but may be related to multifactorial origins. Anyway, reductions in sympathetic activation, in cardiac output, and the maintenance of the peripheral vascular resistance that decrease after exercise, may be the physiological mechanisms to promote PEH. [16],[17],[18],[19],[20]

A population study conducted by Stamler showed that small decreases in BP can protect the cardiovascular system. Reductions in SBP can protect the cardiovascular system. Reductions in SBP of 2-5 mmHg may decrease the risk of infarction in 6-14% and the risk of coronary heart disease in 4-9%, also reducing mortality from all causes by 3-7%. These data are relevant when analyzing the results of the present study, in which a significant reduction in SBP of approximately 14.0 mmHg as a result of chronic resistance training for 4 months was observed. In addition, a chronic reduction of 3.6 mmHg was observed in the EG. This chronic effect reinforces the importance of resistance training to prevent HTN and promote the health of elderly hypertensive people. [21]


  Conclusion Top


The present review concludes that RE training reduces the BP in Indians.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Chaudhary S, Kang MK, Sandhu JS. The effects of aerobic versus resistance training on cardiovascular fitness in obese sedentary females. Asian J Sports Med 2010;1:177-84.  Back to cited text no. 9
    
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Changela PK. A study to compare the effect of aerobic and resistance training on cardiovascular fitness in young obese sedentary females. Int J Health Sci Res 2015;5:1-6.  Back to cited text no. 10
    
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Patel H, Desai D, Desai D. A study to evaluate the changes in blood pressure values of hypertensive patients post aerobic and progressive resistance exercise (PRE). Int J Health Sci Res 2013;3:183-89.  Back to cited text no. 11
    
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Jaiswal AV, Kazi AH, Gunjal SB, Tawde PM, Mahajan AA, Khatri SM. Effectiveness of interval training versus circuit training exercises on blood pressure, heart rate and rate of perceived exertion in individual with prehypertension. Int J Health Sci Res 2015;5:149-56.  Back to cited text no. 12
    
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Shenoy S, Arora E, Sandhu J. Effects of progressive resistance training and aerobic exercise on type 2 diabetics in Indian population. Int J Diabetes Metab 2009;17:27-30.  Back to cited text no. 13
    
14.
Arora E, Shenoy S, Sandhu JS. Effects of resistance training on metabolic profile of adults with type 2 diabetes. Indian J Med Res 2009;129:515-9.   Back to cited text no. 14
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